NDO – American and Japanese immunologists James P. Allison and Tasuku Honjo were awarded the 2018 Nobel Prize in physiology and medicine on October 1, for their discovery of cancer therapy by inhibition of negative immune regulation. In Vietnam, from the end of 2017, the Ministry of Health has officially circulated drug treatments for cancer by immunotherapy.

According to Doctor Pham Tuan Anh, from the Hanoi-based K Hospital, there are many methods of immune treatment in cancer with the general principle being to activate the immune system to identify and attack cancer cells.

The most effective and widely-used therapy that has been recognised as an important tool in cancer treatment are the monoclonal antibodies that control the checkpoint inhibitors with the common drugs, namely Pembrolizumab, Nivolumab, Atezolizumab and Durvalumab. The two Nobel Prize-winners also researched the cancer-resistant mechanism through using such monoclonal antibodies.

Professor Nguyen Chan Hung, Chairman of the Vietnam Cancer Society, said that the recent Nobel Prize-winning immunotherapy is essentially the use of drugs intended to neutralise and inhibit cancer checkpoints.

Accordingly, T-cells of the immune system present in the human body constantly patrol the body for signs of disease or infection and attack. When T cells start to attack, the immune system boosts a series of molecules to avoid harming normal tissues.

The same scientific research has been approved by the Ministry of Health and is being tested in several major hospitals, such as the Ho Chi Minh City Oncology Hospital, Hanoi’s K Hospital, Cho Ray Hospital and Binh Dan Hospital. The project has initially brought about positive results.

At the K Hospital, Dr. Dao Van Tu, Head of the hospital’s Centre for Clinical Trial Research, said that from 2016, several patients undergoing treatment abroad used immunosuppressive drugs upon returning to Vietnam. However, at the end of 2017, with the permission from the Ministry of Health, the facility has officially applied this cancer treatment. To date, the K hospital has treated dozens of patients with immunotherapy.

Information from the K Hospital revealed that the US Food and Drug Administration (FDA) approved the first immunosuppressive inhibitors to treat late stage malignant melanoma in 2011. The life expectancy of patients with this late-stage disease is usually measured in months, however, new immunotherapy prolongs their life for years.

Just three months after the decision, the FDA expanded the therapy for treating late stage lung cancer. Research proved it is effective in treating bladder, kidney, liver, head and neck cancer in 2015. Most recently, there have been successful reports of the treatment of blood cancer, malignant lymphomas and several digestive and gynecological cancers.

"Not every cancer patient has an indication for this treatment, but it mainly depends on the stage and characteristics of the tumor. Typically, this therapy is used for the metastatic stage, and the higher the level of PD-L1 expression on the tumor, the higher the responsive level to the therapy is,” Doctor Pham Tuan Anh said. At the K Hospital, the drug has been shown to be effective in patients with lung cancer and is being expanded to treat other diseases. At present, the hospital has treated dozens of patients and it needs a longer follow-up period to review and evaluate the effectiveness of the treatment, Anh added.

Professor Nguyen Chan Hung also noted that this method cannot be used for all cancer patients but usually applies to patients with untreated, terminal and metastatic cancer. As in the early stages of cancer, measures such as surgery or chemotherapy can be very effective. In addition, the immunosuppressive drug is only available to patients with checkpoint inhibitors, not everyone can use. In fact, roughly 20% of patients taking immunosuppressive drugs show positive results.

Currently, Pembrolizumab is a typical and important drug in cancer immunotherapy and has already been introduced in Vietnam, but is not yet covered by health insurance. The cost for one treatment cycle is approximately VND60 million. Each patient must use one or two vials once every three weeks.

Immunotherapy is currently only one among the five cancer treatments currently available, including surgery, radiotherapy, chemotherapy, immunotherapy and hormone therapy. This measure effectively supports other therapies, but it is quite cost effective, and sometimes limited compared to the remaining measures. "Immunotherapy is not a complete cure for metastatic cancer but only destroys certain parts and inhibits the growth of cancer cells. For the effective treatment of cancer, it is necessary to apply multi-paradigm and comprehensive measures, no single method can bring success," Doctor Pham Tuan Anh emphasised.